title: The resting status of the coronary microcirculation is a predictor of microcirculatory function following elective PCI for stable angina.
abstract: OBJECTIVE
  We performed a prospective study to investigate markers of percutaneous coronary intervention (PCI) related microvascular injury.
  
  
  METHODS
  Consecutive patients undergoing PCI for stable angina were studied. The index of microvascular resistance (IMR) was measured using a temperature and pressure sensing guidewire (TPSG) before and after single vessel PCI. Basal transit-time (TmnBase), that reflected non-hyperemic blood flow was also measured. Fasting bloods were taken to measure blood sugar, HbA1c and lipids. Asymmetric dimethylarginine (ADMA) was also measured as a marker of systemic endothelial function.
  
  
  RESULTS
  55 patients were included in the study. Mean age was 59.9 ± 11.2, 74.1% male. There was no significant difference in IMR post PCI compared with pre PCI values (IMR pre PCI = 16.96 [11.5,25.38] vs. IMR post PCI 14.2 [10.37,26.25] p = 0.96). IMR post PCI was higher in diabetic (DM) patients compared with non-diabetics [IMR post DM = 22.72 (13.35,42.91) vs. no DM = 13.9 (10.18,21.45), p = 0.02]. Fasting blood sugar, HbA1c and IMR pre PCI were correlated with post PCI IMR. IMR pre PCI, HbA1C and fasting glucose were higher in patients who developed PCI related microvascular dysfunction. The strongest independent predictor of post PCI IMR was the pre PCI IMR.
  
  
  CONCLUSIONS
  The baseline status of the microcirculation is an important determinant of post PCI microvascular function. Diabetics appear to have higher post PCI IMR.
authors.affiliation: Department of Cardiology, St Vincent's Hospital, Fitzroy, Australia; Department of Medicine, University of Melbourne, Australia. Electronic address: jamielayland@hotmail.com.
authors.forename: Jamie
authors.initials: J
authors.lastname: Layland
authors.forename: Chris
authors.initials: C
authors.lastname: Judkins
authors.forename: Sonny
authors.initials: S
authors.lastname: Palmer
authors.forename: Rob
authors.initials: R
authors.lastname: Whitbourn
authors.forename: Amy
authors.initials: A
authors.lastname: Wilson-O'Brien
authors.forename: Andrew
authors.initials: A
authors.lastname: MacIsaac
authors.forename: Andrew
authors.initials: A
authors.lastname: Wilson
mesh_terms: D000368:Aged; D060050:Angina, Stable / Q000503:physiopathology / Q000601:surgery*; D015331:Cohort Studies; D003326:Coronary Circulation / Q000502:physiology*; D017558:Elective Surgical Procedures / Q000009:adverse effects / Q000639:trends*; D005260:Female; D006801:Humans; D008297:Male; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000639:trends*; D011183:Postoperative Complications / Q000175:diagnosis / Q000503:physiopathology; D011237:Predictive Value of Tests; D012146:Rest / Q000502:physiology*; D014655:Vascular Resistance / Q000502:physiology
keywords: Angina; Diabetes; Microcirculation; PCI